Postural Considerations During Retina Examination at the Slit Lamp: Positional Adjustments to Patients and Equipment May Reduce the Risk of Musculoskeletal Symptoms in Ophthalmologists
Safeer F. Siddicky1, MS; Gregory W. King2, PhD; Scott E. Olitsky2, MD
1University of Missouri-Kansas City, 2Children’s Mercy Kansas City
Kansas City, MO
Introduction: Ophthalmologists often maintain static, un-ergonomic postures during their routine clinical examinations, which may lead to musculoskeletal symptoms (MSS) and decreased capacity for healthcare delivery. Ophthalmologists’ posture and ergonomics are currently evaluated using qualitative survey methods. Motion capture and electromyography may provide an objective, quantitative methodology to examine posture and suggest postural adjustments that will reduce the risk of developing MSS.
Methods: 10 pediatric ophthalmologists performed simulated retina exams on a child CPR manikin using a slit lamp and a 90D lens. Postural kinematics and muscle activity were measured using marker-based motion capture and electromyography, respectively. Examinations were performed under 3 conditions: No postural adjustments, postural adjustment by altering slit lamp platform height and patient position, and elbow rest placement under arm holding 90D lens, along with postural adjustment. Neck flexion angle and neck and shoulder muscle activity were compared among these 3 conditions for all ophthalmologists.
Results: Neck flexion angle range of motion decreased significantly after postural adjustment (41.8±10.9° vs. 36.8±9.2°, p = 0.041) and elbow rest placement (41.8±10.9° vs. 36.3±9.2°, p = 0.045). Trapezius muscle activity decreased after postural adjustment (0.02±0.02V vs. 0.01±0.005V, p =0.182) and elbow rest placement (0.02±0.02V vs. 0.01±0.007V, p =0.262). Paired t-tests were used to compare these variables.
Discussion: The observed reduction in neck flexion and shoulder muscle activity after postural adjustments may indicate lower exposure to sustained non-neutral neck postures that can cause MSS.
Conclusion: Quick postural adjustments may decrease the risk of MSS by reducing time spent by ophthalmologists in non-ergonomic postures.
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